Post Contents List
Antiplatelet, Anticoagulant & Fibrinolytic Therapy
ANTIPLATELET, ANTICOAGULANT AND FIBRINOLYTIC THERAPY
- Arterial and venous thrombosis with embolic phenomenon like deep vein thrombosis, pulmonary embolism and other embolizations result in morbidity and death.
Drugs which prevent thromboembolic phenomenon are:
|Drugs which prevent thromboembolic phenom enon|
- 1. Drugs which inhibit platelet aggregation
- 2. Drugs which inhibit thrombin and fibrin generation.
- These affect cyclooxygenase (COX), adenosine diphosphate receptors, platelet adhesions, glycoprotein (Gp), and thrombin.
- Gp lIb j IIIa on platelet surface is the final common pathway for platelet activation. Therefore, inhibiting this results in anticoagulation.
- It causesPneumothorax Symptoms Causes Diagnosis Treatment with emergency. Read more ... » COX inhibition and prevention of thromboxane A2 synthesis, leading to decreased platelet activation and aggregation. The effect of aspirin occurs within 1 hour and lasts for 1 week. Dose is 75-325 mgjday.
- Ticlopidine and Clopidogrel inhibit ADP-induced platelet aggregation.
- The CAPRIE trial on these drugs demonstrated reduction in ischemic events in patients with MI and peripheral arterial diseasePneumothorax Symptoms Causes Diagnosis Treatment with emergency. Read more ... ».
Gp lIb / IlIa antagonists
- These are disintegrins which suppress fibrinogen e.g. AbciximabAbciximab Drug info with Brand name and Price. Read more ... », Tirofiban.
- They are widely used in coronary artery disease.
ANTICOAGULANT DRUGS Heparin
- Unfractionated heparin (UFH) molecules bind to antithrombin potentiating its action and inactivating factor Xa and thrombin.
- This prevents and treats thrombosis in patients. Unfractionated heparin can be given IV or subcutaneously.
- It requires monitoring of aPTI – activated partial thromboplastin time.
- Antidote is protamine sulphate.
Low molecular weight heparin
- These are derived from cleavage of unfractionated heparin into low molecular weight compounds.
- They have more of anti-factor Xa but less of antithrombin activity.
- They are safer for use in patients of unstable anginaApproach to Chest Pain Differential diagnosis of chest pain. Read more ... », MI (myocardial infarction), DVT(deep vein thrombosis). Lab monitoring is not required.
- Examples are dalteparin, enoxaparin etc.
- Act as anticoagulant by activating heparin co-factor – II. Only used if heparin causes thrombocytopenia.
- Once weekly dose may be given for primary or secondary prevention of thromboembolic phenomenon.
Direct thrombin inhibitors
|Direct thrombin inhibitors|
- It inhibits vitamin K reductase and prothrombin. It is not used in pregnancy.
- During Warfarin therapy PT – prothrombin time and INR are measured.
- INR of 2-3 is recommended.
- In prosthetic valves INR of 2.5 to 3.5 is recommended. INR is patients PT( prothrombin time) divided by the mean PT.
FIBRINOLYTIC DRUGS STREPTOKINESE
- This is obtained from beta hemolytic streptococci cultures.
- It is antigenic and can even cause anaphylaxis.
- It is used in MI and DVT (deep vein thrombosis) to lyse the clots.
- It is obtained from human fetal kidneyDiabetic Nephropathy and Renal complications of DM (Diabetes Mellitus). Read more ... » cell cultures or recombinant urokinase from mammalian tissue cultures.
- Tissue type plasminogen activator (RTPA) Recombinant tissue type plasminogen activator is used to treat DVT, pulmonary embolism, acutePneumothorax Symptoms Causes Diagnosis Treatment with emergency. Read more ... » MI and acute strokes.
Indications for Anticoagulation
- That’s the short description about thrombosis, anticoagulant treatmentPneumothorax Symptoms Causes Diagnosis Treatment with emergency. Read more ... », etc.· DVT – antocoagulants for 6 wks to 6 months
- · Pulmonary embolism – 6 months
- · Prosthetic heartExamination of the Cardiovascular System. Read more ... » valves – lifelong
- · MI – for variable duration